The present invention generally relates to implantable medical devices (IMDs). Specifically, the invention relates to a system providing real-time communication between the IMDs, medical instruments associated with or compatible with the IMDs, and a specialized remote expert data center, a central IMD support information network, or other remote collaborators. A display may be provided to allow users, particularly remote users, to track connection status and progress. More specifically, the invention relates to a central network to provide for a easily-accessed connection to the expert data center, central IMD information center, or other remote collaborators to promote reliable real-time connectivity between clinicians, IMDs and related medical devices as well as providing remote monitoring for proactive patient therapy and clinical care. The expert data center may be a web-enabled remote server which stores device registration and patient management data.
In the traditional provision of any medical services, including routine check-ups and monitoring, a patient is required to physically present themselves at a provider""s office or other clinical setting. In emergency situations, health care providers may travel to a patient""s location, typically to provide stabilization during transport to a clinical setting, e.g., an emergency room. In some medical treatment applications, accepted medical practice for many procedures will naturally dictate physical proximity of medical providers and patients. However, the physical transport of patients to various clinical settings requires logistical planning such as transportation, appointments, and dealing with cancellations and other scheduling complications. As a result of such logistical complications, patient compliance and clinician efficiency may suffer. In certain situations, delays caused by patient transport or scheduling may result in attendant delays in detection of medical conditions including life-threatening situations. It is desirable, therefore, to minimize situations in which the physical transport of a patient to a particular clinical setting is required.
After the implantation of an IMD, for example, a cardiac pacemaker, clinician involvement with respect to the IMD has typically only begun. The IMD usually cannot be merely implanted and forgotten, but must be monitored for optimal results, and may require adjustment of certain parameters or settings, or even replacement, in response to or in anticipation of changes in patient condition or other environmental factors, or based on factors internal to the device. IMDs may also contain logic devices such as digital controllers, which may need to undergo firmware or software upgrades or modifications. In addition, information about the IMD may be gathered for treatment or research purposes. For example, many IMDs are capable of storing certain state information or other data regarding their operation internally.
Because IMD operation and patient physiology is preferably monitored to help effect the desired patient outcome, it would be desirable if data collected by an IMD could be viewed and administered remotely. Similarly, it would also be desirable that the instructions installed in an IMD may be modified in response to patient physiologic information, or perhaps be upgraded remotely as well.
In the event a change, modification or reprogramming of the IMDs is indicated, it would be desirable if the instruction could be implemented in the IMD as soon as possible, thus providing more continuous monitoring to proactively effect changes in the IMDs for efficient therapy and clinical care. This scenario may be contrasted with a reactive practice of responding to an adverse patient event or subjecting the patient to the inconvenience or expense of frequent in-person encounters with a clinician, for example after an unexpected therapy by the device, or to effect other monitoring of device functioning, e.g., spontaneous therapies by the device. For example, an implanted cardioverter defibrillator may administer to the host patient a cardioversion or defibrillation therapy. After such therapy, it is typically desirable to determine the parameters of, for example, an arrhythmia that a therapy was administered in response to, or of the therapy administered.
Prior art methods of clinical services, particularly IMD monitoring and adjustment, are generally limited to in-hospital procedures or other scenarios involving patient transportation to a clinical setting. For example, if a physician needs to review the performance parameters of an IMD in a patient, it is likely that the patient has to go to the clinic. Further, if the medical conditions of a patient with an IMD warrant a continuous monitoring or adjustment of the device, the patient would have to stay in a hospital indefinitely. Such a continued treatment plan poses both economic and social problems. Under the prior art, as the segment of the population with IMDs increases, many more hospitals and clinics, and attendant clinicians and service personnel will be needed to provide in-hospital service for the patients, thus escalating the cost of healthcare. Additionally, the patients will be unduly restricted and inconvenienced by the need to either stay in the hospital or make very frequent visits to a clinic.
Yet another condition of the prior art practice requires that a patient visit a clinic center for occasional retrieval of data from the implanted device to assess the operations of the device and gather patient history for both clinical and research purposes. Such data is acquired by having the patient in a hospital/clinic to download the stored data from the IMD. Depending on the frequency of data collection, this procedure may pose serious difficulty and inconvenience for patients who live in rural areas or have limited mobility. Similarly, in the event a need arises to upgrade the software of an implantable medical device, the patient will be required to come into the clinic or hospital to have the upgrade installed.
In addition to the patient concerns described above, the implantation and ongoing administration of a medical device must be carefully documented or recorded by various clinicians and commercial entities. For example, a clinician may wish to record information about the device such as its serial and model number in order to inform the patient of any firmware or software updates or upgrades involving the device, and to issue reminders to the patient regarding significant dates involving the IMD in order to generally aid in patient compliance. The IMD may also have a regular maintenance period suggested or prescribed, for example, for renewal of a power supply or refill of a reservoir containing a drug administered by the device. Similarly, the manufacturer and/or seller of the device will probably wish to record information about the device such as its serial and model number, manufacturing date, its batch or lot, the patient receiving the implant, the clinical entity administering the device, and the like, in order to ensure than any important information that may involve the device may be promptly provided to the patient either directly or indirectly. In addition, the manufacturer may be engaged in demographic or cohort clinical studies or data collection regarding etiological and device outcome scenarios across a population receiving a certain medical device or general category of medical device. Furthermore, the manufacture may wish to track demand of various product lines in order to determine which products or types of products are subject to greater demand, and accordingly should receive a greater investment of health care research and supply funds. In particular, the manufacturer will wish to maximize the likelihood that an implantable medical device will be available to a patient that needs one.
In general, then, the administration of an IMD may require ongoing involvement by various clinicians and medical personnel, the decisions and input of whom may materially affect the decisions that the other involved clinicians make on an ongoing basis. Accordingly, collaboration between these clinicians and coordination of their various treatment decisions and prescriptions is desirable. However, the mobile nature of the modern medical professional""s practice is well-known. A single physician, for example, may be affiliated with multiple different hospitals, offices, and other clinical settings, as well as with various corporate and professional entities. In addition, the typical clinician""s busy schedule often makes it difficult if not impossible to predict where he or she may be reached at a particular time. The profession""s relatively early deployment of pager technology is demonstrative of the highly mobile character of medical practice. Further complicating the ability of clinicians to communicate with each other is the fact that they are frequently involved in medical procedures where interruptions are, at best, inconvenient. In general, a medical professional may have multiple and unpredictable phone numbers leading to uncertainty as to where they can be reached, particularly with regard to wired telephone devices presently most suitable for reliable data transfer.
Advancements in IMD and related technologies have made it possible to effect certain IMD administration telephonically, i.e. effecting data communications over Plain Old Telephone Service. For example, IMDs may be telephonically connected with remote devices that may need to send or receive information with respect to the IMD. However, maintaining an address book on a medical instrument requires a significant time investment for the user to enter contact information. Further, each contact may have multiple and unpredictable telephone numbers depending on the clinicians"" location at any given time. If users must enter or dial telephone numbers in order to communicate with remote medical devices, it complicates their goal of conducting a collaborative patient session with the remote medical instrument. Furthermore, if a central data repository must be accessed in connection with IMD administration, a clinician or technician is presently required to dial one number for data transfer to the central data repository network, and one or more other numbers for collaboration with remote medical devices.
In general, the number of people having implanted medical devices has been increasing over the last few years, with an attendant increase in operator personnel. The total effect of these phenomenon is a widely dispersed and large body of operators. Thus, it is desirable to have a high efficiency communications system that would enhance data communications, both between the IMDs and medical instruments, such as programmers; between operators and entities providing IMD updates and education such as manufacturers, and between clinicians and medical professionals administering IMDs. In a preferred embodiment of the present invention, the centralized collaborative network supports chat, bulletin board, or peer-to-peer instant messaging utilities, in addition to contact and scheduling administration.
In addition to providing an efficient communications network, efficiency would be increased even more if it became possible to limit the degree to which human and particularly clinician involvement is required to effect the communication between an IMD and a remote resource, and to limit clinician, technician, or other human involvement where appropriate in certain aspects of IMD deployment within a patient, once the IMD is implanted. For example, after implantation, the device implanted must be registered. This registration may be linked to the device""s host patient, or may be anonymous.
Further, it may be preferred to have an operable communication between the various implants to provide a coordinated clinical therapy to the patient. Thus, there is a need to monitor the IMDs and the programmer on a regular, if not a continuous, basis to ensure optimal patient care. In the absence of other alternatives, this imposes a great burden on the patient if a hospital or clinic is the only center where the necessary upgrade, follow up, evaluation and adjustment of the IMDs could be made. Further, even if feasible, the situation would require the establishment of multiple service areas or clinic centers to support the burgeoning number of multi-implant patients worldwide.
Specifically, the communication scheme should be tailored to enable real-time communication between the remote data center, the programmer or an interface medical unit and the IMDs. The present invention provides a central network or xe2x80x9cswitchboardxe2x80x9d to facilitate remote connectivity of programmers, IMDs and a preferably web-based expert data/management center to dispense real-time therapy and clinical care to patients worldwide.
According to a representative embodiment of the present invention, a centralized data network is provided with a static xe2x80x9clocationxe2x80x9d which may be accessed by clinicians that are coordinating IMD administration between various remote medical devices and human clinicians. The static xe2x80x9clocationxe2x80x9d, which may be, for example, a telephone number or dedicated IP address, may be hard-coded into software or firmware of various medical devices, allowing network access according to this static location. The centralized network that may be accessed at this location may keep track of dynamic locations and addresses of both devices and humans that may wish to access the network or interact with each other. For example, in a representative embodiment of the present invention, a medical device capable of interfacing with an IMD through telemetry may be supplied with an interface which may provide for access to the central network. Data about the patient stored on this network may be accessed, aiding in the administration of the patient encounter. In addition, other clinicians may be communicated with, for example clinicians also accessing the network at the same time. The medical device interfacing with the IMD may also have, for example, a keyboard and monitor or a voice communication device such as a speakerphone or comparable telecommunications device for voice collaboration.
The central network will preferably be xe2x80x9cawarexe2x80x9d of, or track on a continuous basis all remote medical devices and human clinicians and personnel that are in communication with the central network at any given time. For example, a clinician administering the IMD interface device may consult with a physician at a remote location. This remote physician may have dialed up the central network, or may be connected to the central network via a data communications protocol, e.g. SMTP operating over a public network such as the Internet. The various connections between the remote devices and personnel may be effected as network connections, dial-up data communications connections, direct connections over dedicated lines, voice transmissions over plain old telephone service (POTS), or packetized or other digital voice transmission over data lines, e.g., voice over IP.
In a preferred embodiment of the present invention, if a person or device is not in communication with the central network at a given time, and contact with the person or device is requested by a person or device in contact with the network, the central network will have stored information allowing it to make an educated prediction about where the device or human remote resource may be found, according to, for example, telephone number or IP address.
In a preferred embodiment of the subject invention, one or more buttons or a similarly simple interface may be provided on an electronic medical instrument that will effect a communication link between the medical instrument and a remote central network. Through this remote network, further communications links may be established between the medical instrument on the one hand, and various remote medical instruments, devices, and clinical personnel on the other. These links may be direct links, but are preferably indirect links routed through the central network. In either case, the communications links between devices, or between devices and personnel, provide an interface for the exercise of remote collaboration. For example, a remote medical device having the capability to receive and analyze data from a particular IMD, may be reached via the central network, and be consulted by a clinician in proximity to the IMD. It will preferably not be necessary for the clinician to, for example, know or have access to a telephone number, IP address, or other contact point at which the remote device may be accessed. In addition to eliminating the need for clinicians to use an xe2x80x9caddress bookxe2x80x9d or similar application to keep track of remote contact information, the present invention also prevents problems with misdialing or transcription errors with telephone numbers. In a preferred embodiment of the subject invention, the resultant direct or indirect communications link can be used to establish both data transfer, and human real-time voice collaboration. The present invention also provides a central meeting point that clinicians may arrange to interact over at a certain time, without regard to their respective locations. Furthermore, the meeting time may be arranged by postings to the central network that may be accessed by interested or authorized parties.
In one embodiment of the present invention, a groupware system is provided allowing clinicians to make a connection to another instrument or computer for collaboration purposes, or to the network for data transmission purposes. The present invention may be implemented by, for example, supplying medical instruments with remote collaboration and data transfer capability with a hardware button or software control that is labeled to indicate it will make the connection with another instrument or the central collaboration network.
For example, the button may be implemented as an actual physical pushbutton, or as a GUI element xe2x80x9cbuttonxe2x80x9d on a computer or device monitor that is labeled with the particular instrument or network that the button will effect a connection with, and may be xe2x80x9cpressedxe2x80x9d by clicking on the GUI button with the computer cursor or touch screen. Regardless of whether the button is implemented in software or in hardware, in describing the invention, the interface to effect the connection may be referred to generally as a xe2x80x9cbutton.xe2x80x9d
According to an embodiment of the present invention, medical instruments are further provided with a display that allows the user to observe that a connection to the electronic switchboard has been made, and to make a choice to either transfer data, wait for a collaboration partner to sign on, or choose a collaboration partner from those currently on-line. This display may, for example, be implemented as a local computer monitor connected to the medical device, or may be a hardware component of the medical device. A medical instrument configured to implement the present invention will have the ability to establish and maintain a connection, for example, via telephone line or data network to the central data network. In a preferred embodiment of the subject invention, the central data repository electronic switchboard maintains a connection with each logged-on instrument, and routes each instrument to either the network server for data transfer, or to another instrument that is on-line as chosen by the user. The central data repository network will preferably represent each on-line instrument to other instruments with a unique identifier. This may be, for example, a name, a device serial number, an avatar, i.e. a pictorial or other schematic representation of the device, or another suitable unique identifier. Users and operators of medical instruments and devices may select other medical devices connected to the network by means of this unique identifier. The network may provide various remote users and medical devices and/or their operators with a menu or list of all medical devices which may be accessed, according to their unique identification.
An embodiment of the present invention provides for a central data repository that provides on-line networked collaboration partners that may be accessed by, for example, users of medical devices. These collaboration partners, in turn, may also be medical devices, or may be human clinicians or computer resources accessible to the medical device seeking collaboration. For example, the central data network could provide collaboration partners that are on-line at all times. Alternatively, the central data network may present to a remote user the potential collaborators that are on-line at the present time. In this way, the current invention may provide an xe2x80x9cinstant messagingxe2x80x9d service between and among subscribers, members, or users connected to the network; alternatively, the network may provide a multi-user collaboration session comparable to a xe2x80x9cchat roomxe2x80x9d utility.
In this way, the present invention provides a system for directing and facilitating central collaboration of IMDs implanted in patients, even when the patients are in a location remote from necessary equipment or the clinicians trained in operating the equipment. In one embodiment, the invention may be used to reduce or eliminate the need for a clinician or other person available to administer device administration. The invention may also create a means for gathering device data in advance of its actual review of a clinician. In this embodiment of the invention, a computer remote to the host patient may initiate and subsequently store the contents of IMD device memory uploaded and transmitted to the remote computer. This data would then be available for examination in the future. For example, a referring physician could use the ability to examine the patient remotely as a consultation system.
In one embodiment of the present invention, a programmer unit or other interface medical unit that would connect to the centralized data network and repository may be provided. This central repository may be termed, for example, a remote data center. This remote data center will preferably provide access to an expert system allowing for downloading of upgrade data or other expert medical or device information to a local, i.e., IMD or communications device environment. Further, the invention may be implemented, for example, as an integrated software system for efficient voice and data communications to transfer information between the IMDs and a remote expert data center for dispensation of therapy and clinical care on a real-time basis.
Further, in one embodiment of the present invention, it is possible to enable the gathering of high resolution diagnostic/physiologic data, and to transfer information between the IMDs and a remote data center to dispense therapy and clinical care on a real-time basis. Further, the data system contemplated by the present invention enables an efficient system for data storage, collection and processing to effect changes in control algorithms of the IMDs and associated medical units to promote real-time therapy and clinical care.
The proliferation of patients with multi-implant medical devices worldwide has made it imperative to provide remote services to the IMDs and timely clinical care to the patient. The use of programmers and related interface devices to communicate with the IMDs and provide various remote services has become an important aspect of patient care. In addition to the instant invention, the use of programmers may be implemented in a manner consistent with the co-pending applications detailed in the foregoing Cross Reference to Related Applications, and assigned to the assignee of the instant invention. In light of the disclosures of these incorporated references, the present invention provides a vital system and method of delivering efficient therapy and clinical care to the patient.
In a representative embodiment of the instant invention, one or more IMDs, such as a pacemaker, defibrillator, drug pump, neurological stimulator, physiological signal recorder may be deployed in a patient. This IMD may be equipped with a radio frequency transmitter or receiver, or an alternate wireless communication telemetry technique or media which may travel through human tissue. For example, the IMD may contain a transmission device capable of transmitting through human tissue such as radio frequency telemetry, acoustic telemetry, or a transmission technique that uses patient tissue as a transmission medium. Alternately, an IMD may be deployed in a fashion by which a transmission or receiving device is visible externally to the patient but is connected directly or via wires to the IMD. An external device, which may generally be termed an interface medical device or interface medical unit, may be positioned outside the patient, the interface medical device being equipped with a radio frequency or other communication means compatible with the communication media of the IMD or the IMD transmitter/receiver, which may be external to the IMD and may further be external to the patient. Communication may be effected between the IMD transmitter/receiver and the external interface medical device, e.g. via radio frequency. The interface medical device may be connected via a wireless or physical communication media, e.g. via modem and direct dial connection, with the central expert computer or network. In an alternate embodiment of the subject invention, the interface medical device may have a direct connection or tunneled connection directly to the central network. In yet another alternate embodiment of the subject invention, the system may be implemented as a data network that allows the interface medical device access to the central expert network and various distributed devices from many locations, for example providing for an interface medical device that is portable.
The amount of historical data, particularly patient-specific historical data used as input to control systems can be virtually unlimited when it is stored externally to the patient. Furthermore, a more thorough comparison can be made between patients with similar diseases as data and therapy direction are centralized, which may be expected to result in gains to the body of medical knowledge and treatment efficacy. Data from other medical systems, either implanted or external, such as etiological databases, can be incorporated easily into the central expert system. Other anonymous patient experiences or treatment data may be more quickly incorporated into a subject patient""s IMD regime than might be possible with existing systems of IMD programming or upgrading. In addition, a subject patient""s own historical treatment parameters and corresponding outcomes may be used in making IMD programming and other treatment decisions. In general, the instant invention provides IMD clinicians engaged in collaboration with access to virtually unlimited computing power as part of their data collection and therapy calculation processes.
A collaboration system according to the present invention provides the ability to have high power computing systems interact with implanted medical devices, thus providing the ability to use complex control algorithms and models in implanted medical devices. In addition, even with relatively simple modeling, or in stochastic models, relatively large amounts of historical data from a single or multiple medical devices may be brought to bear for predictive purposes in evaluating alternate therapy and IMD instruction prescriptions. The present invention provides a system that establishes an external communications device and data network as a xe2x80x98data busxe2x80x99 for extending the processing power of deployed IMDs, while minimizing host patient and clinician inconvenience by allowing remote collaborators.
The present invention may be effected, in part, by the provision of an interface medical device, which may be a standalone device or a computer peripheral device, that is capable of connecting an IMD, or simply data telemetrically received from an IMD, to a central network or other data communication link. While the interface between a computer data link and an implanted medical device is referred to generally herein as a xe2x80x9cinterface medical devicexe2x80x9d, or the like, it will be appreciated to those skilled in the art that the interface may serve as an interface to a variety of data communications systems, including not only networks, but also, without limitation, direct dial-up connections, dedicated lines, direct satellite links, and other non-network data communications connections.
In one embodiment of the invention, the information network may be established or operated according to any network protocol, for example, TCP/IP over the Internet. The uploading to a central collaboration computer may also be effected over a direct dial-up connection or a dedicated line. Upon uploading of the data, a medical professional or other clinician may be alerted to the fact the data has been uploaded. This clinician may then view the data, if desired.
In an alternate embodiment of the invention, for example, a host patient may effect a dial-up connection to the central data network. In addition to evaluation of device function during routine situations, according to this embodiment of the present invention, a home monitoring instrument may be provided to a host patient allowing the patient to send data, i.e., to effect central collaboration, if, for example, they have a subjective belief that they are symptomatic. For example, a host patient of a cardioverter defibrillator IMD may effect central collaboration if they believe they have suffered an arrhythmia event. The data resulting from the central collaboration may then be made remotely accessible for evaluation by a pacing system expert. In a preferred embodiment of the subject invention, IMD function data and physiologic data of the host patient is made available nearly instantaneously to a clinician capable of evaluating the device function, physiologic event or data, or therapy administered by the target IMD.
In a preferred embodiment, the central collaboration network of the present invention is implemented as a software application which may be run on a server or central computer accessible via a network or direct connection by the interface medical device. In an alternate embodiment, the interface medical device may be implemented as a software client which may run on a computer remotely from the collaboration server. Preferably, the central collaboration computer, program or device is capable of autonomously and dynamically determining the model of an IMD, for example, according to manufacturer, type, and model number, as well as the specific serial number of a particular device. When an IMD is within communication range of an interface medical device, the central collaboration computer of the present invention is also preferably capable of configuring a deployed IMD, or commanding the interface medical device to retrieve data from the IMD.
In a representative embodiment, a session according to the present invention may proceed according to the following scenario. In order to begin a collaboration session, a host patient will typically present to an interface medical device, possibly aided by a clinician or technician. For example, the patient may place themselves in the vicinity of the interface medical device within range of the telemetry capacities of the interface medical device. This may take place, for example, at a medical facility such as an Emergency Room, Follow-up Clinic or Operating Room. At the initiation of a session, it will be preferable to configure the target IMD for optimal operation for central collaboration. For example, the interface medical device may be programmed to issue a command to the target IMD to xe2x80x9cCancel Magnetxe2x80x9d, xe2x80x9cResume Therapy,xe2x80x9d or another command to enter a mode consistent with the collaboration process. Either prior to or after the establishment of a telemetry or other communication link with the target IMD, the interface medical device operator will effect a communications link between the interface medical device and the central collaboration network expert computer. This interface medical device operator may be a human attendant or technician, an automated module of the interface medical device firmware or software, or may be implemented as a software application on a general purpose computer connected to the interface medical device. Alternatively, the remote central expert computer may lead a human or automated interface medical device central expert computer through the steps of establishing a telemetry interface between the IMD and interface medical device; with the interface medical device in turn notifying the central collaboration computer when a telemetry connection has been established. Communication with the central collaboration network server may be established via a network connection, such as a LAN or WAN. In this embodiment of the present invention in which the interface medical device is preferably attended by an operator, the operator may be the host patient of the target IMD, or it may be attendant personnel at a clinical setting. In either case, the operator may connect the interface medical device to a suitable network connection, if a network connection is not already in place. For example, a direct dial-up connection may be established in this manner by physically connecting the interface medical device into a telephone connection jack such as a RJ-11 analog jack. The operator at some point would turn the interface medical device on and instruct the interface medical device system to establish communications with a pre-configured telephone number, IP address, or other communication location.
In a preferred embodiment, the central collaboration network and expert system of the present invention is implemented as a software application which may be run on a server or central computer accessible via a network or direct connection by the interface device. In an alternate embodiment, the programmer may be implemented in part as a software client which may run on a computer remotely from the server. Preferably, either the interface medical unit or the central expert center is capable of autonomously and dynamically determining the model of an IMD, for example, according to manufacturer, type, and model number, as well as the specific serial number of a particular device. When an IMD is within communication range of an interface medical device, it is also preferably capable of configuring the deployed IMD, or commanding the interface medical unit to retrieve data from the IMD.